Assuring Pediatric Nutrition in the Community
FREQUENTLY
ASKED QUESTIONS:
Specific Diagnoses - Prematurity
Premature
infants and reflux
Supplemental carnitine
I am working with 2 premature infants who have reflux. They were both released from the hospital with Enfamil AR as the prescribed formula. What information do you have about premature infants and reflux? What about the use of Enfamil AR with premature infants?
Gastroesophageal reflux (GER) is the return of gastric contents into the esophagus and is common in infancy. For healthy, growing babies, GER may be benign, but pathologic GER may require treatment. Preterm infants are at increased risk for GER. Treatment may include small, frequent feedings and special positioning during feeding. In some cases, surgical intervention is necessary. Thickening feedings is a common practice but is somewhat controversial. In some cases, thickened feeds have been shown to increase the duration of reflux episodes. For infants with feeding difficulties, thickened feedings may also aggravate preexisting feeding difficulties.
The two formulas currently being marketed as "thickened" have not been shown to decrease reflux (i.e., no data have been presented to verify this as an effective reflux formula). In addition, the two commercially available thickened formulas have not been tested in preterm infants. These formulas do not meet the vitamin/mineral needs of young preterm infants still in the hospital. In addition, there is no data to support the use of these formulas in preterm infants with reflux after discharge.
Reference
Groh-Wargo S, Thompson M, Cox JH, eds. Nutrition Care for High
Risk Newborns, Revised Third Edition. Chicago IL: Precept Press 2000.
If a premature infant is not breastfeeding when discharged, do the transitional formulas provide carnitine and are these infants able to build up a supply for their growth needs?
Carnitine is necessary for metabolism and oxidation of fatty acids. In children and adults, carnitine can be synthesized in liver and kidney from lysine and methionine. This process is immature in young infants, particularly premature infants (less 34 weeks). In the abscence of a dietary source, preterm infants may exhibit decreased serum carnitine levels and impaired fatty acid oxidation. This is particularly a problem in infants on prolonged TPN (>4 weeks). Cow's milk based formulas and human milk contain carnitine. Soy formulas, protein hydrolysates, and preterm formulas also contain carnitine. Most preterm infants on enteral feeds, especially discharged home, do not need an additional source of carnitine.
Reference
Groh-Wargo S, Thompson M, Cox JH, eds. Nutrition Care for High Risk
Newborns, Revised Third Edition. Chicago IL: Precept Press 2000.